medication administration Flashcards
terminolgy
MAR
-medication administraion record
-legal documentation regarding medication administration
terminology
EMAR
-electronic medication administration record
terminology
bar code administration
-scan band
-system process to reduce (but not eliminate) medication errors
terminology
chemical name
-molecular makeup of medication
-not used in clinical practice often
ex. acetylsalicylic acid
terminology
generic name
-one name given to drug by group who first identified it
ex. aspirin
terminology
trade name
(brand name)
-specific manufacturer, copyrighted to distribute
ex. bayer
who regulates drugs and requires drugs to have uniform purity standards for active ingredients
FDA
describe how medications are classified
-medications are classified by the way they act against disease or disorders (their effects on a body system) or by their chemical composition, or their clinical indications for the therapeutic effect
therapeutic and pharmacologic classification
describe…
therapeutic classification
-the way drugs act against diease or disorders and their effect on a body system
-examples include alagesics and laxatives
what the drug does - physiological change
describe…
pharmacologic classification
-mechanism of action of the drug at the molecular level
-the genera; indications, precautions, and nursing implications are similar in the same pharmacologic classification
-examples: beta blockers and ace inhibitors
describe…
therapeutic effect
desired physiologic response
describe…
adverse effects
anything other than therapeutic effects
name some adverse effects
-side effects
-tolerance
-toxicity
-idiosyncratic effect
-severe adverse effect
-allergic reaction
-anaphylactic shock
describe…
side effects
-can vary from slighly bothersome to so bothersome you may have to switch drug therapies
-ex. ace inhibitors can give a harsh cough
describe…
tolerance
pt requires higher dose over time to achieve same response
ex. opioids
describe…
toxicity
-too much of a drug
-reactions with other drigs
-inhibited metabolism or excretion of a drug (impaired kidneys or liver)
describe…
idiosyncratic effect
-unexpected response
-exaggerated or opposite
describe…
severe adverse effect
-FDA term (reportes to them by pharmacists- may lead to black box warning)
-response to med is life threatening, requiring intervention to prvent death or disability
-or med leads to death, hospitalization, disability, or congenital defects
describe…
allergic reaction
-when there is an immunologic response to the med
-drug is the antigen -> body creates lymphoctes to attack antigen
describe…
anaphylactic reaction
-life threatening
-throat swelling, circulatory collapse
-use epi and call 911
-can premedicate in hospital for anticipated reaction
name some different types of drug interactions
-synergy/synergism
-antagonist/antagonism
-incompatibility
-teratogenic
describe…
synergy/synergism
-better together
-multiple drugs work better when used together than when given alone
describe…
antagonists/antagonism
drugs that reduce, alter, or interfere with the effect of another drug
describe…
incompatibility
-chemical compatibility if liquid (primarily injectable) medications
-just look it up
describe…
teratogenic
-interaction of med with developing fetus
-most dangerous in first trimester
not tons of info on it
describe…
pregnancy category A
no risk to the fetus in any trimester
describe…
pregnancy category B
no adverse effects demonstrated in animals; no human studies
describe…
pregnancy category C
studies with animals have shown adverse reactions; no human studies; given only after risks to the fetus have been considered
describe…
pregnancy category D
definite fetal risk; only given if life threatening condition exists
describe…
describe pregnancy category X
absolute fetal abnormality; not to be used anytime in pregnancy
terminology
onset
-amount of time for the therapeutic effect to begin
-varies based on med and dose
terminology
peak
time when concentration in blood is highest
terminology
duration
how long therapeutic effect lasts
effects dosing frequency
terminology
trough
-sample of blood is taken prior to next scheduled dose (should be at lowest concentration)
-measured to evaluate metabolism of drug
terminology
plateau
consistent concentration in blood with repeated fixed doses
terminology
half-life
amount of time it takes to reduce concentration by half through elimination
terminology
therapeutic range
-blood draw to ensure there is effective concentration but not toxic
-can vary between drugs
name some different medication orders
-routine
-standing
-prn
-single
-stat
-telephone or verbal orders
-medication reconciliation
describe…
routine orders
-usual order
-keep giving until order is discontinued
describe…
standing orders
-if X, then Y
-ex. if BS less than 35, give insulin
describe…
PRN orders
-as needed
-more freuqent than standing and can be for comfort, or be more lifethreatening
describe…
single orders
happen once
describe…
stat order
-immediately
-usually for life threatening situations
-can be given before a pharmacist signs off on it
describe…
telephone or verbal orders
-verbal communication with prescriber
-has to be urgent
-take out something to write on
-read back
describe…
medication reconciliation
-process of reviewing meds at every change of location of pt
reviewing for duplications and omissions
what are the med administration essentials
-triple check
-three checks
-six rights
-patients rights
-pre administration assessment
-evaluation
describe…
triple check
-visually confirm the medication:
1. when the nurse reaches for the med
2. when the dose is in the nurses hand
3. one last time before administering to the patient
describe…
three checks
-different from triple check
1. check med order
2. check pt allergies
3. check meds expiration date
describe…
6 rights
-right drug
-right dose
-right route
-right time
-right patient
-right documentation
name some different routs of med administration
-oral
-sublingual
-buccal
-enteral
-inhalation
-topical
-parenteral
what are some different types of topical administration
-transdermal
-opthalmic
-otic
-nasal
-rectal
-vaginal
name some different types of parenteral administration
-intradermal
-subcutaneous
-intramuscular
-intravenous
-epidural
-intrathecal
describe…
patients rights
right to…
-information
-careful assessment
-informed consent
-safe administration
-supportive therapy
-have no unecessary medications
describe…
pre administration assessment
evaluate…
-include both direct and indirect data
-med history
-allergies
-current med list
-diet history/diet order
-neurological problems
-current condition
-lab values
-physical assessment
describe…
evaluation
-when is this completed?
-determine therapeutic effect
-determine adverse effects
describe…
polypharmacy
lots of drugs
describe…
misuse
using a medication other than as prescribed
describe…
noncompliance
not following the plan
describe…
vitamins, supplements, and OTC
as special considerations with med administration
can interact and does interact with other medication
when should you remove meds from individual dose packaging?
keep meds in packaging until immediately prior to administration
also only the person who prepared the med should administer it
should you leave meds unattended?
nope
medication security and verification of medication
what do you do with unused medications?
unused medications need to be disposed of following special rules
can you withhold medications?
yes. withhold medications based on your assessment and collaboration with physician
describe controlled substances
when talking about administration
regulated by federal law
(who can prescribe, specific record keeping, procedures for dispensing and wasting)
med errors are due to…
-can be due to human error and/or syste ineffectiveness
-violation of one of te 6 rights
what phase of the administration process can med errors occur?
can occur at each phase of the process:
-ordering
-transcribing
-dispensing
-administering
what factors can lead to an administration-relted med error?
-miscommunication
-too many patients
-knowledge deficit
-fatigue
-complacency
-distractions
what are some processes and systems to reduce errors?
-tallMAN letters (used for lookalike soundalike drugs)
-high alert medications (meds that have increased risk if error occurs)
-dual verification
in the event of an error…
what do you do???
-assess patient immediately (collect data to determine what you need to assess)
-notify physician (may need supportive treatment, reversal agents, tests, monitoring)
-complete incident report
describe patient centered care
as it applies to safe med administration
if possible, adapt to patients normal schedule and routine
describe teamwork and collaboration
as it applies to safe med administration
there are many people invlolved with med administration. including:
-pharmacists
-prescribers
-nurses
-nursing assistants
-respiratory therapists
describe EBP
as it applies to safe med administration
how we administer meds comes from evidence based practice
describe quality improvement
as it applies to safe med administration
think aboiut errors before they occur
describe safety
as it applies to safe med administration
know what you dont know
describe informatics
as it applies to safe med administration
-EHR
-med resources online
